Objective To study the neural mechanism of hypotension or shock state in acute cholangitis in severe type (ACST) and its value of clinical application. Methods A technique of blocking abdominal splanchnic nervi via right adipose capsule of kidney was carried out on 28 patients by injecting 1% lidocaine before urgent operation. Results After blocking the relevant nervi, hypotension or shock state in 23 patients were improved significantly (Ｐ＜0.05). The death rate was lower (14.3%) after having performed biliary decompressions with laparotomy. Conclusion Patients′ hypotension or shock state at the early phase of ACST is the result of neural reflex in which the splanchnic nervi is its afferent pathway. Blocking the relevant nervi before urgent operation, the valuable opportunity of emergency treatment can be obtainded and the complication and death rate are reduced significantly.
目的 总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎（SAC）提供参考。方法 回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果 156例行PTCD均获成功,1次穿刺成功140例，其成功率达89.7%（140/156）; 16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解，黄疸减退，肝功能改善。结论 PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者，其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。
【Abstract】Objective To investigate the anatomic structure and experimental methods of peribiliary vascular plexus(PVP) in rat’s hepatic portal bile duct.Methods To observe the morphological structure of PVP in rat’s hepatic portal bile duct after the hepatic artery was perfused with Chinese ink and transparency management, performed and to make three dimensional reconstruction of PVP’s spacial structure in MoticBuaa3Dvol software.Results The microvascular distribution and plane structure of PVP in rat’s hepatic portal bile duct could be shown clearly through Chinese ink perfusion and transparency management. The three dimensional structure of PVP could be reconstructed effectively by MoticBuaa3Dvol software, its effect was verisimilitude. Conclusion Chinese ink perfusion and vitrification is a simple and easy method in PVP’s morphologic study of rat’s hepatic portal bile duct. MoticBuaa3Dvol software is useful in microvascular study of hepatic portal bile duct.
Thirty patients of primary cholangiolithiasis were treated by the use of a rigid choledochoscope passing through the left lateral liver lobe for removal. 20 cases of them were manipulated with mini-incisions, the stones in 14 patients (70.0%) were completely removed. In the remaining 10 cases of conventional laparotomy, left lateral liver incised in 4, left lateral lobectomy in 6 before rigid choledochoscopic lithotomy; the stons were completely removed in eight patients (80.0%). No case had complications, the short-term effect of the method is obviously better than that of other various operative treatments. It has the advantages of less trauma, less pain, and quick recovery. It is a economical and effective new technique and has prospects of application.
Objective To comment the diagnosis and treatment the bile leakage from the injuried abnormal minute biliary in our laparosicopic cholecystectomy (LC) practice. Methods Fourteen cases of minute biliary duct injury in 2 050 cases of LC were studied retrospectively. Among them, 6 cases had been found the points of leakage during operation, and the points were treated by titanium nips. In 4 cases even though the bile leakage could be seen, but the points of leakage could not found, and were treated by drainage. Four cases with peritonitis, 1 needed to be explored, and treated with suture ligature, 1 was explored by laparoscopy again, another two cases were treated with multiple hole catheters to drainage of the abdominal cavities through stab wounds. Results All 14 cases recovered. Conclusion Small bile leakage in LC is almost inevitable. It is the best that the bile leakage can be discovered during operation and to be treated. If it is discovered after operation, an open or laparoscopic exploratory laparotomy and adequate drainage would be needed. In the case of small amount of leakage, catheter drainage through stab wound is feasible.
The comparison made between two experimental models with obstructive jaundice, which were newly established reversible model and traditional bile duct ligation and internal drainage model, showed that the new model was superior to the traditional one. This study suggests that the new model would be an ideal model, which could replace the traditional one for studying obstructive jaundice.
Objective To explore the feasibility and safety of laparoscopic cyst resection and Roux-en-Y hepatojejunostomy in treatment for adult congenital cholangiectasis and to compare the therapeutic effects of laparoscopic procedure with conventional open procedure. Methods The clinical data of 33 adult patients with congenital cholangiectasis from May 2008 to September 2011 in the department of general surgery of Shengjing Hospital of China Medical University were retrospectively analyzed. Fourteen patients received laparoscopic procedure （laparoscopic group），whereas the other 19 patients received conventional open procedure （conventional group）. Results All the operations were carried out successfully through laparoscopic procedure. The mean time of operation in the laparoscopic group was significantly longer than that in the conventional group （195min versus 130min，P＜0.01）. The average intraoperative blood loss in the laparoscopic group was significantly less than that in the conventional group （80ml versus 270ml，P＜0.01）. In contrast，the mean time of bowel peristalsis recovery and postoperative hospital stay in the laparoscopic group were significantly shorter than those in the conventional group （time of bowel motion recovery：76h versus 104 h，P＜0.01；hospital stay：6.1 d versus 9.6 d，P＜0.01）. There were no differences in the early complications between two groups （P＞0.05）. Conclusions Totally laparoscopic treatment for congenital cholangiectasis in adult is feasible and safe. It is worth to be generally applied because of its minimal invasion and fast postoperative recovery.
Twenty five children with congenital biliary dilatation were treated with hepatico-jejuno-duodenostomy following excision of choledochal cysts between 1983 and 1985. The age ranged from two months to eleven years. The last follow-up ranged from 6-9 years (mean 7.5 years). All patients were free of jaundice with normal growth and development and none had peptic ulcer. The results from the last follow-up was better than that of the first one. This procedure was safe, effective and physiologically appealing.
Objective To investigate the anatomic factors on iatrogenic biliary injury for elevating surgical safety and decreasing incidence of iatrogenic biliary injury. Methods The clinical data of 39 patients with iatrogenic biliary injury and anatomic varied factors in operation records from January 2000 to August 2009 in The Second Affiliated Hospital of Kunming Medical College were analyzed retrospectively. Results Thirty-nine patients with iatrogenic biliary injury were divided into 5 types according to Bismuth typing, including type Ⅰ 6 cases, type Ⅱ 19 cases, type Ⅲ 8 cases, type Ⅳ 5 cases, and type Ⅴ 1 case. Anatomic varied factors included bile duct variation in 15 cases, cystic duct abnormal position in 10 cases, vascular variation in 13 cases, and porta hepatis rotation in 1 case. Biliary injuries were found during operation in 6 cases, 24—72 h after operation in 16 cases, and stenosis of biliary duct was found in 17 cases 3 months to 2 years after operation. Two cases were dead because of liver function failure or myocardial infarction, withdraw was 4, the other patients were cured. Conclusion Anatomic factors are important objective elements in iatrogenic biliary injury, paying attention to abnormal anatomic factors can effectively prevent iatrogenic biliary injury.